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Falls or fractures with androgen receptor inhibitors According to the results of a systematic review and meta-analysis reported in JAMA Network Open, treatment of prostate cancer with androgen receptor inhibitors (ARIs) is associated with an increased risk of falls or fractures. The study searched the Cochrane, Scopus and MedlinePlus databases through to August 2019. Eleven randomised clinical trials in 11 382 men compared ARIs alone or with androgen deprivation therapy (n=6536) to placebo, bicalutamide or abiraterone recipients (controls; n=4846). Patients were 43–97 (median 72) years of age. The median duration of treatment was 15 vs 8 months for ARI recipients versus controls, respectively. The incidence of falls was 8% vs 5% (relative risk [RR] 1.78; 95% CI 1.42, 2.24), with a grade ≥3 fall incidence of 1% vs 0.6% (RR 1.63; 1.27, 2.08). The fall rate was greatest for apalutamide (12%), followed by enzalutamide (8%) and darolutamide (4.2%). Similarly, the incidence of fractures was 4% vs 2% (RR 1.59; 1.35, 1.89), with a grade ≥3 fracture incidence of 1% vs 0.5% (RR 1.71; 1.12, 2.63). Again, the fracture rate was greatest for apalutamide (10%), followed by darolutamide (4.2%) and enzalutamide (1.8%). "Our study suggests that the use of ARIs is associated with a higher risk of fall and fracture", note the authors, although "it is still a rare adverse event". They add that "considering the severity of the disease and that ARIs have shown significant improvement in overall survival, the benefits may outweigh the risk of fall and fracture is some individuals". Myint ZW, et al. Evaluation of Fall and Fracture Risk Among Men With Prostate Cancer Treated With Androgen Receptor Inhibitors. A Systematic Review and Meta803521019 analysis. JAMA Network Open : 17 Nov 2020. Available from: URL: http://dx.doi.org/10.1001/jamanetworkopen.2020.25826

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Reactions 12 Dec 2020 No. 1834